Transcript Cervical Traction

Spinal Traction
Cervical & Lumbar
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Traction
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Traction is the process of drawing or pulling the
spinal column to apply a longitudinal force to the
spine & associated structure, this force separates the
vertebrae, opening the intervertebral space
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It is therapeutic tools that falls in the area of
exercise because of its effect on the musculoskeletal
system and use in stretching and mobilizing
techniques.
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How Does Traction Relieve Pain?
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Increasing the space
between vertebrae
Separating the
apophyseal joints
Widening the
intervertebral foramina
Removing pressure on
injured tissue
Reducing muscle spasm
Increasing peripheral
circulation
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Relaxing muscles
Changing intervertebral
disk pressures
Tensing the posterior
longitudinal ligament
Creating suction to draw
protruded disks toward
their center
Flattening an abnormal
lumbar curvature
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Physiological effects on Bone
 Increases spinal movement, overall and between
each vertebrae
 Reverses immobilization-related bone weakness by
increasing or maintaining bone density
Physiological Effects on Ligament
 Creates ligament deformation, thereby increasing
movement and decreasing impingement problems
 Long-term effects
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Physiological Effects on Articular Facet Joints
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Increases the separation between joint
surfaces
Decompresses articular cartilage, allowing
synovial fluid exchange to nourish the
cartilage
May decrease degenerative changes
May decrease pain perception
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Physiological Effects on Muscles
Lengthens tight muscles and allows
better muscular blood flow.
 Activates muscle proprioceptors,
further decreasing pain
Physiological Effects on Nerves
- Decreases compression forces on
nerves
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General Principles
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Angle of pull
Neutral: Transverse plane
 Flexion/Extension: Frontal plane
 Unilateral: Sagittal plane
 Multiaxial: Two or more planes
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Anatomical differences
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Cervical inferior facet joints angle anteriorly
• Flexion opens facet joints
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Lumbar facets angled posteriorly
• Extension opens facet joints
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General Principles
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Tension
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No clear formula
The traction must overcome the resistance exerted
by the soft tissue
Use the least amount of tension needed to relieve
symptoms
Duration is inversely related to tension
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Factors that influence the amount
of vertebral separation
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Spinal Position: the greater the amount of flexion that the spine is placed before
traction, the greater the vertebral separation.
Amount of force applied:
In cervical spine: a force of approximately 7% of the body weight separate the
vertebrae. A minimum force of 11.25 to 13.5 Kg is necessary to lift the weight of the
head when sitting to counteract the resistance of muscle tension.
In lumbar spine: a minimum force of half of the body weight is necessary for mechanical
separation.
Angle of pull:
In cervical spine: the angle of pull creating the greatest posterior elongation is 35
degree.
In lumbar spine: pulling from the posterior aspect of the pelvis rather than from the sides
is necessary to cause flexion of the spine.
Position of patient: the patient should be in comfortable and relaxed position. Many
patients report feeling more relaxed supine than sitting for cervical traction.
Duration of application: 20 to 25 minutes is applicable time.
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Types of Traction
1- Static or Constant Traction, which may be:
- Continuous or prolonged: static traction in which the force is
maintained for several hours.
- Sustained: a static traction in which the force is maintained
from few minutes up to one-half hour.
2- Intermittent Traction
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Alternately applied and withdrawn traction at frequent
interval.
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Mode of application:
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Mechanical: using various types of equipment.
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Manual: Administered by the therapist
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Positional: through positioning to elongate the involved tissue
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Indications
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Muscle spasm
Hypomobility of the joints from joint
dysfunction or degenerative disk changes
Herniated or protruding disks
Nerve root compression
Facet joint pathology
Capsulitis of vertebral joints
Anterior/posterior longitudinal ligament
pathology
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Cervical
Disc
Herniation
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Lumbar Disc Herniation
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Contraindications
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Absolute
Spinal infections
Spinal Cancer
Spinal Cord pressure
Rheumatoid Arthritis
Osteoporosis
Relative
Ligamentous strains and hypermobility
Acute stage of injury
Traction anxiety
Cardiac or respiratory insufficiency
Pregnancy
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Limitations of Traction
 The effect of vertebral separation is
temporary
 No consistent protocol exist, rational is
hypothetical with inconsistent clinical results.
Precautions
 Complete patient’s evaluation should be done
before traction.
 Close monitoring of patient should be
performed throughout treatment.
 Can cause thrombosis of internal jugular vein
if excessive duration or traction weight is
used.
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Cervical Traction
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Generally applied with the patient supine or sitting
 Supine preferred because it eliminates gravity
Three main types
 Manual
 Positional
 Mechanical
Application of a longitudinal force to the C-spine & structures
Tension applied can be expressed in pounds or % of patient’s
body weight.
 At 7% of patient’s body weight, vertebral separation begins
Human head accounts for 8.1% of body weight (8-14 lbs.)
 Greater amount of force is needed widen areas
 You want force to be about 20% of body weight
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Cervical Traction Set-up
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Neck – placed in 25-30° flexion
 Straightens normal lordosis of C-spine
 Must have at least 15° flexion to separate facet
joint surfaces
Body must be in straight alignment
Duration – 10-20 minutes most common
Remove any jewelry, glasses, or clothing that may
interfere
Lay supine, place pillows under knees
Secure halter to cervical region placing pressure on
occipital process & chin (minor amount)
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Cervical Treatment Set-up
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Align unit for 25-30° of neck flexion
Remove any slack in pulley cable
On:Off sequence 3:1 or 4:1 ratio
Following treatment, gradually reduce tension & gain
slack
Have patient remain in position for a few minutes
after treatment
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Manual Cervical Traction
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To perform manual cervical traction
 Clinician sits at head of table facing
patient
 Head is cradled to allow distraction
of cervical vertebrae without hurting
patient
 Traction is applied
• Head is slowly moved to
maximize relaxation and comfort
How to slowly move head into
relaxation and comfort
 Neutral position pain: affecting upper
cervical vertebrae
 Flexed 30° pain: affecting lower
cervical vertebrae
 Lateral flexion pain: pressure on
spinal nerves with radiating pain into
arms or hands
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Cervical Traction Positioning
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Supine – support lumbar region (bend knees, or
hang lower legs over end of table & place feet on
chair); allows musculature to relax
Therapist standing at the head of the treatment
table, supporting the weight of the patient’s head in
his hands.
Flex the head until motion of the spinous process
just begins at the determined level. Support the
head with folded towels at the level of flexion, then
side bend the head away from the side to be
distracted until movement of the spinous process
begins.
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Mechanical Cervical Traction
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Harness traction
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Harness traction
device hung over a
doorway
Amount of tension
adjusted by patient
As patient pulls one
click on the pulley, 1
lb of pressure is
applied, separating
the vertebrae.
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Mechanical Cervical Traction
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Table traction
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Mechanical intermittent or sustained table traction
Involves use of head harness attached to mechanical
device at end of table
Device can pull sustained or intermittent traction
• Usually 30 sec on, 10 sec off
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Initiation of Treatment
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Set controls to zero and turn on unit
Remove slack
Adjust Ratio
 Normally 3:1 or 4:1
Tension
 Approximately 10 pounds or 7% of body weight
 First exposure use lower tension
Duration
 Corresponding to pathology
Termination of Treatment
- Tension
Gradually reduce over 3 or 4 cycles
Gain slack and turn unit OFF
- Remove halter from unit and patient
- Patient remains in position for 5 minutes after the
treatment
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Lumbar Traction
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There are more types of lumbar traction
than cervical traction.
Some of the most commonly used
techniques are presented.
To be effective, lumbar traction must
overcome lower extremity weight (½ of
body weight)
Friction is a strong counterforce against
lumbar traction
 Split table is used to reduce friction
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Manual Lumbar Traction
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Allows the clinician to feel patient’s reaction to
treatment
Can be used as examination technique
Clinician uses her hands or a belt to pull on
patient’s legs, separating vertebrae
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Manual Lumbar Traction
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Single-leg traction
 Manual traction
 Requires two clinicians
 Patient is prone or supine.
 One clinician supports patient’s torso, while other
puts traction on leg exhibiting radicular pain.
 After a series of five, 30 sec bouts, patient lies
supine at edge of table and stretches affected hip
flexors (which are usually tight)
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Manual Lumbar Traction
(L3-4, L4-5, L5-S1)
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Manual Lumbar Traction
(T12, L1, L1-2, L2-3)
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Unilateral Leg Pull Manual Traction
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Counter-traction harness needed
From ankle flex hip 30, ABD hip 30 and ER
fully
Apply steady traction along long axis of LE
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Mechanical Lumbar Traction
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Uses a specialized table that separates when adequate forces
are applied
• Patient’s head and trunk are on one half; hips and legs are on other
half.
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One end of belt or strap is attached to patient; other end
is attached to mechanical device that separates table
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Mechanical Lumbar Traction
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Traction Force
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No separation < ¼ BW
Can be delivered in either sustained or intermittent mode
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Lumbar Positional Traction
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Bilateral Foramen Opening
 Athlete in supine
 Hip/knees flexed
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Lumbar Positional Traction
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Unilateral Foramen Opening
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Sidelying position
Pillow between iliac crest and
lower border of ribs
Flex hip/knees until LS is
forward
Trunk rotation toward
superior shoulder
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Lumbar Positional Traction
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Supine
Knees to chest
 Forward bend of lumbar spine
 Separation of Spinous
processes
 Increased size of
intervertebral foramen
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Unilateral Lumbar Positional
Traction
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Unilateral Lumbar Positional Traction
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